1. Field of The Invention
The present invention relates to medical service industries and more specifically, to systems, methods, and program products for delivering medical services from remote locations.
2. Description of the Related Art
Typically, when a person suffers an illness or injury, that person must have transportation to a medical facility for diagnosis and treatment of the illness or injury. Managed healthcare is an important service provided to various non-medical facilities or institutions, such as, for example, correctional facilities, remote military or scientific bases, and large ships e.g. factory and cruise ships, etc., that have a patient clinic and/or a patient infirmary. Most of such facilities do not, however, have the internal resources to fully provide for all the branches of patient care. Further, smaller communities may be unable to afford a properly staffed medical facility or hospital, may not have enough of a population to support various medical specialties typically serviced by specialist physicians, or may have both adequate finding and population but nevertheless may have an inadequately staffed medical facilities due to physician recruiting difficulties.
In less modern times, the delivery of medical services did not require the level of training and education that is required today. For example, historically, most severing wound infections were treated through amputation rather than application of a regiment of antibiotics and/or localized surgery. Due to the advances in modern medicine, the number of illnesses and injuries that can now be treated have significantly increased while the number of properly trained in educated physicians, especially specialist physicians, have not kept pace. As a result, the difficulty of providing timely and cost efficient patient access to such medical professionals has become increasingly complicated, especially in the various non-medical facilities, institutions, and communities, described above, that are unable to support their own fully staffed hospital staffed with a sufficient number of physicians to provide adequate coverage for each medical specialty.
For this reason, facilities such as, for example, most large correctional facilities, outsource healthcare to external entities. Other facilities, such as smaller correctional facilities, remote military bases, and the various types of ships, along with small communities, generally either outsource healthcare to the external entities or contract with the external entities to have the requisite medical professionals visit their facilities to perform their respective medical services. Even through the use of outsourcing and the use of external contracts, generally there is still an insufficient pool of specialist physicians. Further, even when there is adequate physician resources, under normal conditions, there is generally an insufficient pool of substitute physicians to provide coverage where a physician is sick or otherwise unable to service his or her appointment schedule.
Also, even when a substitute physician or specialist physician is available, a significant amount of such physician's time is wasted in transporting the physicians between their “home” location and the location of the patient. Thus, patients often either need to be transported great distances in order to obtain such services, maximizing the available time of the physician, or the physician is transported to the patients, the result being a fewer number of patients are provided service than would otherwise be, corresponding to the time delay in transporting the physician to the patients.
The concept of telemedicine has been in existence for several years and is used widely throughout the country. Such systems, however, are difficult to use, provide poor imaging quality, and either do not provide for real-time feedback between the patient and physician or provide insufficient feedback such that it can not be considered a sufficient substitute for an in-person scheduled routine visit. Further, because telemedicine in its current form does not properly integrate the use of electronic medical records, pharmacy formularies, or medical protocols that reduce the need for discretion on the part of a patient care provider, they provide for an ineffective and non-standardized utilization of the physician resources. Still further, because such systems tend to be implemented either ad hoc, provide block-time physician availability, or are merely established to monitor a patient's condition without real-time patient-physician interactivity, they do not lend themselves to provide cost efficient utilization and prioritization of a remotely positioned physician's available time. Stated another way, they do not provide a physician centered system for delivering healthcare, and thus, ineffectively utilize limited physician resources; the result being difficulty in a patient obtaining desired medical services and increased costs in obtaining such service, when available.
Thus, there is a need for an integrated healthcare delivery system that brings healthcare to the patient rather than the patient to healthcare by utilizing 21st century technology. Particularly, there is a need for an integrated healthcare delivery system capable of providing medical services delivery to a patient by a remotely separated physician of such quality and functionality that it can be considered an equivalent if not superior substitute for an in-person consultation. Further, there is a need for an integrated healthcare delivery system that integrates the concept of telemedicine with electronic medical technology, medical protocols, and electronic billing to provide healthcare to patients anytime and anywhere from a remote facility and in both a resource efficient and a cost efficient manner.
In addition to the need for such an integrated healthcare delivery system that provides for communication between the physician and the patient, federal regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), related to confidentiality and privacy of individual health records, have created an additional complicating factor for those involved in dealing with medical records in the provision of medical services. The medical records, whether in paper or electronic form, are required to be kept confidential and safeguards are required to be taken to protect such records. For example, many providers have a stated policy prohibiting transfer of information related to an individual's medical record by facsimile transmission because they do not deem this to be a secure transmittal method. Security measures are required to be implemented by those providing healthcare services to limit or control access to confidential medical records. Thus, there is also a need for an integrated healthcare delivery system that can allow for private secure communication of healthcare data between the physician and the patient and throughout the system.
Although generally management of chronic diseases is enhanced by maintaining a proper medication regiment, little data is available to perform statistical analysis to determine to what extent deviations from a proper medication regiment effect management of such chronic diseases. Even with the advent of electronic medical records, data is often created and placed sporadically in different records situated at remote locations, making such data difficult to access for analysis.
In connection with special facilities such as, for example, nursing homes, assisted living facilities, and correctional facilities, however, data related to patients is maintained to provide the respective facilities with accurate administrative records. Such facilities that have implemented record keeping using electronic records also maintain electronic medical records or medical histories of the patients. The medical records typically have been developed and maintained either by the facilities or by a third party that has been providing healthcare services for the facility system. As described in co-pending U.S. patent application Ser. No. 10/806,878 by Clements et al., titled “Pharmaceutical Inventory and Dispensation Computer System and Methods,” incorporated by reference, the electronic medical records can be used to accurately record such events as, for example, provider visit results, prescription histories, lab work results, and the like.
Medicinal administrators within such facilities are also required to maintain records associated with the physical administration and dispensation of prescribed medication to patients. With respect to correctional facilities, for example, inmates by law must have proper medical care while in the custody of the correctional facilities. Inmates historically have filed lawsuits against the correctional facilities claiming that they have been denied proper medical care. To provide sufficient evidence that the correctional facilities has exerted its best efforts to provide proper medical care, the correctional facilities can maintain records indicating the time, type, and dosage of medication that was administered to an inmate. A prison guard, present during medication administration, ensures that the inmate actually consumed the prescribed medication, unless, as in rare circumstances, the inmate was allowed to keep the medication on his or her person, which is referred to keep-on-person medication. The correctional facility can further keep records indicating whether or not the inmate has actually consumed the medication.
These medical records, and those associated with the other forms of special facilities, can be so specific that, with proper masking of the data with respect to the identification of the patient, researchers can have a readily available database of highly accurate medication administrations including medication route, dose, frequency, duration; and most importantly, compliance, for a plethora of medications that can allow for long-term studies on such medications generated literally at a “moments notice” and without the requisite time delay of forming a test group in order to formulate and execute such studies. Further, due to the use of electronic medical records, this concept could be applied to an entire integrated healthcare system whereby such data can be kept for other members of the populace serviced by such a system, if such system were in existence. Thus, clearly there is a need for an integrated healthcare system that accurately stores patient medication administration data in electronic medical records adequate to provide for statistical analysis of various medications dependent upon the various delivery attributes including medication administration compliance.